Secondary glaucoma due to isolated thrombosis of superior ophthalmic vein
C. A. Binder¹, M. Bechmann¹, G. Fesl², D. Klaas³, B. Roesen¹, A. Kampik¹
Purpose: We report about isolated thrombosis of superior ophthalmic vein, leading to one-sided episcleral venous stasis and secondary glaucoma.
Methods: We performed slit-lamp examination, tonographic measurement, visual field testing, orbital ultrasound examination, conventional digital subtractive angiography (DSA), magnetic resonance tomography (MRT), flow-sensitive magnetic angiography (MRA). For treatment we employed in Cyclo-photo-coagulation (CPC). Orbital decompression surgery was anamnestically known.
Results:Disc cupping, atrophy, elevated intraocular pressure and glaucomatous visual field loss were present. Orbital ultrasound examination showed dilated V. ophthalmica superior and led to suspicion of Sinus cavernosus fistula. MRT and flow-sensitive MRA excluded Sinus cavernosus fistula. Conventional DSA gave evidence of isolated thrombosis and malformation of superior ophthalmic vein. Treatment consists of CPC. Intraocular pressure was reduced to normal range.
Conclusion:We observe and report about isolated thrombosis of superior ophthalmic vein as a cause of secondary glaucoma for the first time. This was independent to Carotis-Sinus cavernosus fistula. Malformation of the superior ophthalmic vein probably leads to isolated thrombosis. DSA, MRT and flow-sensitive MRA are very important to find the cause of episcleral venous stasis. Substantial for physicians is to know that isolated thrombosis could be a cause of idiopathic episcleral venous stasis (Radius-Maumenee-syndrome). CPC is an effective treatment of this manifestation of secondary glaucoma.
¹Department of Ophthalmology, Ludwig-Maximilians-University,
²Department of Neuroradiology, Ludwig-Maximilians-University, Munich, Germany
³Contract practice Klaas/Borchart, Friedberg, Germany